Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | DO637 | AL |
NPI | 1811913544 |
---|---|
Provider Name | Kurt W Kantzler |
First Address | Gadsden, AL 35901-4217 |
Second Address | Gadsden, AL 35901-4217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009937130 | (05) | AL |
H01688 | (02) | AL |